Welcome to the INFORMATION SESSION

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1 1 Welcome to the INFORMATION SESSION Quality Improvement MOC Learning Collaborative: Improve Mental Health Screening in Pediatric Practice

2 Web Conference Rules & Etiquette To see presentation- click on link in meeting invitation Can hear audio two ways: Dial in by phone Log in via computer Please limit background noise & conversation Use MUTE button if available Never use HOLD (avoid practice recorded on-hold messages) Questions encouraged- only 1 person can speak at a time Identify yourself by name & practice Can also use messaging feature to either group or individuals

3 Thank You to Our DC Collaborative for Mental Health in Pediatric Primary Care American Academy of Pediatrics, DC

Children s Healthcare Quality Children s National Health Network Department of Behavioral Health DC Department of

Notice of Grant Agreement # CHA.PSMB.CNMC.PGRM-C.052013.

3 3 Thank You to Our DC Collaborative for Mental Health in Pediatric Primary Care American Academy of Pediatrics, DC Chapter DC Department of Behavioral Health DC Department of Health Care Finance DC PICHQ: Partnership to Improve Children s Healthcare Quality Children s National Health Network Department of Behavioral Health DC Department of Health: This project made possible through a sub-grant agreement with DC Department of Health Title V program. Notice of Grant Agreement # CHA.PSMB.CNMC.PGRM-C The views and opinions contained in this presentation do not necessarily reflect those of DC Department of Health or the US Department of Health and Human Services, and should not be construed as such.

4 4 Agenda Background: DC Collaborative for Mental Health in Pediatric Primary Care Why routine mental health screening? Challenges of screening QI MOC Learning Collaborative Overview Benefits of participation Details Next Steps

Working Group - American Academy of Pediatrics (DC Chapter) - Children s National Health System - Children s Law Center - DC Department of Behavioral Health - DC Department of Health - DC Department

5 Working Group - American Academy of Pediatrics (DC Chapter) - Children s National Health System - Children s Law Center - DC Department of Behavioral Health - DC Department of Health - DC Department of Health Care Finance - Georgetown University - U of Maryland DC Collaborative for Mental Health in Pediatric Primary Care Project team Disciplines represented: - Advocacy - Education - Pediatrics - Policy - Psychiatry - Psychology - Social Work Funding Sources: - DC Department of Health Title V Block Grant Program - Howard and Geraldine Polinger Family Foundation Advisory Board (Partial Listing) - DC Behavioral Health Association - DC Public Schools - GW University - HSCSN - Howard University - Mary s Center - Office of CM Alexander - Office of the Deputy Mayor (HHS) - Strong Start DC - Total Family Care Unity Health Care - Zero to Three

Integrated Evaluation and Treatment Routine, Universal MH Screening Expert Resource Payment Reform

6 Activities-Initiatives Support for Practices Support for Families Integrated Services Policy- Advocacy Resource Guide Education and Training Behavioral Health Access Program Integrated Consultation Integrated Evaluation and Treatment Routine, Universal MH Screening Expert Resource Payment Reform Access to Services Family Navigators Coordinated Systems of Care Perinatal Depression and Anxiety Evaluation and Research

7 Why Universal Mental Health Screening? High unmet mental health needs: 20% of children with MH problems, yet only 20% of them receiving care 100% of DC-based pediatric providers surveyed agreed there is a high level of unmet need for mental health treatment in children PCPs need to play a significant role in addressing needs: 96% of primary care providers agreed that they are expected to identify and address mental health problems Difficult to identify MH issues w/o screening tools: Sensitivity rates for pediatric providers are low (14%-54%) Few parents (17.7%) who report elevated problems on screening tools spoke to a provider about these issues Brief screening tools can help to identify issues: Brief screening in early childhood can predict 67.9% of children found to have MH disorders in early elementary school 7

8 8 Medicaid Screening Requirement MH surveillance MH screening As of 7/1/2013, the DC Department of Health Care Finance new 5-year contracts with the DC Medicaid Managed Care Organizations (MCO s) [MCO] shall require annual Mental Health & Substance Abuse screenings by the enrollee s PCP. DMH (now Department of Behavioral Health) must approve the screening tool used by the [MCO s] PCPs. Currently approved screening tools (though more will soon be added): 0 66 months: Ages and Stages Questionnaire: Social- Emotional (ASQ:SE) 3 21 years: Strengths and Difficulties Questionnaire (SDQ) years: Patient Health Questionnaire-9 (PHQ-9)

(to screen and improve my practices) There

Content concerns I m not a mental health

9 9 Challenges of Screening Logistical concerns I m too busy! (to screen and improve my practices) There are no mental health resources! Content concerns I m not a mental health provider I don t have the training to handle positive screens! Pandora s box In DC, ~1 in 10 PCPs said they are usually able to meet the needs of children w/mh problems.

10 10 We are here to help!! There is a gap between what we know is recommended best practice and what we actually do in busy practice setting Quality Improvement is a structured approach to measuring and improving care Applies improvement science & methods to busy practice setting through small incremental changes Ongoing Quality Improvement now required by specialty boards (ABP and ABFM) for maintenance of certification (MOC) We coach and support practitioners in quality improvement through structured QI learning collaborative

colleagues Receive complimentary resources (*DC practices): AAP Addressing Mental Health Concerns in Primary Care: A

11 11 Benefits of QI Project Participation Learn how to identify and manage MH concerns Expand knowledge of child mental health and increase comfort level via education from local mental health professionals and support from colleagues Receive complimentary resources (*DC practices): AAP Addressing Mental Health Concerns in Primary Care: A Clinician s Toolkit ASQ:SE starter kit Provider-friendly DC mental health resource guide: dchealthcheck.net Get CME & MOC credit

12 12 We ve done this before really! Quality Improvement expertise DC PICHQ (DC Partnership to Improve Children s Healthcare Quality) (2005) Children s National Health Network and CNMC Goldberg Center for Community Pediatric Health spread improvement regionally Part of National hip Network (NIPN) Successful regional QI projects: Preventive Care/EPSDT (DC Medicaid) ( ) Childhood Immunizations ( *) Patient Centered Medical Home (2010) Childhood Obesity (2011*) Childhood Asthma (2012*, 2013*) Childhood Mental Health (2014*) *ABP Part 4 MOC Approved CNHN now recognized by the American Board of Pediatrics as QI MOC Portfolio sponsor organization

13 QI LC model produces great results! Significant practice improvement in screening practices during Round 1 of the Learning Collaborative % 80% Baseline Nov (n=55) Goal (50%) 87% 83% 76% 87% 60% 40% 26% 26% 20% 0% 11% MH screening completed? 1% AppropriateMH MH screening scored Used code for Screening Tool Used and documented MH screening

14 Mental Health Screening QI Learning Collaborative Who? DC pediatric practices Maryland and Virginia practices can also participate When? January June 2015 (option of continued support after that) Where? In your own office & on the web Why? Universal mental health screening required in new MCO contracts Clinical need Professional credit ABP & ABFM MOC Part 4 QI credit (25 points) CME credit (up to 30 hours) 14

15 15 Specific Aim Statement & Target Measures Between Jan June 2015, practices will improve their office screening and management of childhood MH concerns as measured* by increasing: Provider/practice readiness to perform annual mental health screenings for culturally diverse patients (pre- & post-project survey) % of annual well child visits where a DBH-approved screening tool is administered (50% of visits) % of mental health screenings (using DBH-approved tool) that have scored documentation of results (50% of visits) % where administration of a screening tool is appropriately coded and/or billed using CPT code (75% of screens) % of positive screens completed and billed (using 96110) in which TS modifier is appropriately coded (75% of screens) *Targets may be adjusted based on benchmark chart audits

QI Learning Collaborative Project Components Brief data gathering & feedback to measure progress: 3 Plan-Do-Study Act Cycles Web-based learning conferences (live and recorded) by MH experts Monthly

16 QI Learning Collaborative Project Components Brief data gathering & feedback to measure progress: 3 Plan-Do-Study Act Cycles Web-based learning conferences (live and recorded) by MH experts Monthly practice team meeting to look at data & implement mini-improvements Monthly team leader project calls with practice champion (local leader) and other practices to share data, successes, failures and tips (speak with experts, new practices, and practices that are doing screening)

17 Project Measures Provider Surveys (do individually): Pre- and post- Brief (<5 min) to assess current attitudes and practices AAP Practice Readiness Inventory (do as team): Pre- and post- Assess

17 17 Project Measures Provider Surveys (do individually): Pre- and post- Brief (<5 min) to assess current attitudes and practices AAP Practice Readiness Inventory (do as team): Pre- and post- Assess readiness to address mental health problems in 5 domains Chart Audits: Baseline period (6-months pre-qi) & then monthly Submit electronically via user-friendly tools Areas Assessed: MH screening completed? Tool used? (ASQ: SE, SDQ, PHQ-9, Other) MH screening scored and documented? Screening score in the clinical range? Coded or billed for screening using CPT code? Coded TS modifier for positive screens? How were MH issues addressed?

Practice Feedback: Data Report Cards 18 Provider Name Count of charts Percent of All Approved Screens used by provider (%) Elshady Bekele 2 20% 50% Clarissa Dudley 2 20% 100% Heidi Schumacher 1 10%

18 Practice Feedback: Data Report Cards 18 Provider Name Count of charts Percent of All Approved Screens used by provider (%) Elshady Bekele 2 20% 50% Clarissa Dudley 2 20% 100% Heidi Schumacher 1 10% 0% Shaunte Henry 1 10% 0% Cesar Machuca 1 10% 100% Rosella Castro 1 10% 100% Megan Gray 1 10% 100% Nathalie Quion 1 10% 100% Avg. Age Reviewed 5.7 yrs. old Total Number of Charts 10 Project Tracking Measures Yes Response Year 1 Final Practice Avg Monthly Practice Avg Project Aim Distance from Goal Appropriate MH screening completed 7 70% 50% -20% Appropriate MH screening tool used 7 88% 50% -38% Screening scored and documents 4 50% 50% 0% Screening scored in the clinical range 3 75% NA Project Billing Measures Used code for MH screening Used -TS modifier if MH screen was positive Mental Health QI Learning Collaborative-Track 2 November Practice Score Card:Practice Name Practice Code: AA Yes Response Year 1 Final Practice Avg Monthly Practice Avg Project Aim Distance from Goal 6 86% 50% -36% % 50% Project Follow-up: Actions Taken by Screening Tool Medicaid Approved Tools Actions Completed. Count Percent Referral made parent accepted 0 0% ASQ:SE Patient already connected with services 0 0% Referral made parent refused 0 0% Provider managed 0 0% Referral made parent accepted 0 0% SDQ-Parent Report Patient already connected with services 1 33% Referral made parent refused 0 0% Provider managed 2 67% Referral made parent accepted 0 0% SDQ-Self Report Patient already connected with services 0 0% Referral made parent refused 0 0% Provider managed 0 0% Referral made parent accepted 0 0% PHQ-9 Patient already connected with services 0 0% Referral made parent refused 0 0% Provider managed 0 0% Mental Health issues addressed when appropriate screening tool used 3

19 19 Team-based practice improvements You develop and test small changes in your practice Model for improvement: Plan-Do- Study-Act Keep it simple! Tips and examples from coaches and practices Evaluate PDSA success (or not), make adjustments and pilot as needed Track results

20 Web-based learning sessions Lunchtime learning (~1 hr) Web-based sessions from MH experts Screening Overview & Implementation QI 101 After the Screen Motivating and Supporting Families to Address

20 20 Web-based learning sessions Lunchtime learning (~1 hr) Web-based sessions from MH experts Screening Overview & Implementation QI 101 After the Screen Motivating and Supporting Families to Address Mental Health Managing Behavior Problems Managing Anxiety Perinatal Mental Health Archived for later viewing Can also watch archived webinars from Round 1 (e.g., Early Childhood Mental Health) CME accredited

21 21 Project website: QI Team Space QI project website to submit and see practice data Archived learning sessions, videos & webinars Practice resources for improving MH screening and intervention

Project Timeline: Track 1 (New Sites) Optional January February March April May June July - Sept Feb Team Leader Call: Thurs 2/19

6/18 Summer Team Leader Call: TBD Kick-Off Part 1 1/9/14 Kick-Off Part 2 1/12/14 Learning Session #1: DATE TBD Learning Session #2:

Meeting Practice Team Meeting Practice Team Meeting Practice Team Meeting Practice Team Meeting Practice Team Meeting Baseline Chart

Chart Audits (15) Pre-Provider Survey Mid-QI Balancing Survey Post Provider & Balancing Survey AAP Practice Readiness Inventory PDSA

22 Project Timeline: Track 1 (New Sites) Optional January February March April May June July - Sept Feb Team Leader Call: Thurs 2/19 March Team Leader Call: Thurs 3/19 April Team Leader Call: Thurs 4/16 May Team Leader Call: Thurs 5/21 June Team Leader Call: Thus 6/18 Summer Team Leader Call: TBD Kick-Off Part 1 1/9/14 Kick-Off Part 2 1/12/14 Learning Session #1: DATE TBD Learning Session #2: DATE TBD Learning Session #3: DATE TBD Learning Session #4: DATE TBD Learning Session #5: DATE TBD Practice Team Meeting Practice Team Meeting Practice Team Meeting Practice Team Meeting Practice Team Meeting Practice Team Meeting Practice Team Meeting Baseline Chart Audits (30) Feb Chart Audits (15) March Chart Audits (15) April Chart Audits (15) May Chart Audits (15) June Chart Audits (15) Summer Chart Audits (15) Pre-Provider Survey Mid-QI Balancing Survey Post Provider & Balancing Survey AAP Practice Readiness Inventory PDSA Cycle Progress Report 1 (Jan-Feb) PDSA Cycle Progress Report 2 (March-April) PDSA Cycle Progress Report 3 (May-June) AAP Practice Readiness Inventory

23 23 We are recruiting practices now! Kick-off: Part 1: Friday Jan 9 th 12-1pm Part 2: Monday Jan 12 th 12-1pm Basic requirements: Internet connectivity

24 24 How do I sign up or ask questions? Sign up online at: Questions about signing up? Contact Tamara John at or tjohn@childrensnational.org Questions about the DC Collaborative for Mental Health in Pediatric Primary Care? Contact Lee Beers (lbeers@childrensnational.org) or Leandra Godoy (lgodoy@childrensnational.org)

25 25 Thank you for participating! Questions & discussion.

Mental Health Screening in Pediatric Primary Care: Results from a Quality Improvement Learning Collaborative

Leandra Godoy, PhD, Melissa Long, MD, Tamara John Li, MPH, Mark Weissman, MD, Lee Savio Beers, MD April 1, 2016 Society for Behavioral Medicine Mental Health Screening in Pediatric Primary Care: Results